Provider Demographics
NPI:1073723722
Name:MASON, DOROTHY MARIA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:MARIA
Last Name:MASON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8670 W 91ST PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9064
Mailing Address - Country:US
Mailing Address - Phone:219-365-3998
Mailing Address - Fax:
Practice Address - Street 1:8670 W 91ST PL
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9064
Practice Address - Country:US
Practice Address - Phone:219-365-3998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002693A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist